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  • 1.
    Fritz, Johanna
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gusdal, Annelie K
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eklund, Caroline
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives2024In: JMIR Aging, E-ISSN 2561-7605, Vol. 7, no 1, article id e43999Article in journal (Refereed)
    Abstract [en]

    Background: Older people are particularly vulnerable to social isolation and loneliness, which can lead to ill-health, both mentally and physically. Information and communication technology (ICT) can supplement health and social care and improve health among the vulnerable, older adult population. When ICT is used specifically for communication with others, it is associated with reduced loneliness in older populations. Research is sparse on how the implementation of ICT, used specifically for communication among older people in social services, can be performed. It is recommended to consider the determinants of implementation, that is, barriers to and facilitators of implementation. Determinants related to older people using ICT tools are reported in several studies. To the best of our knowledge, studies investigating the determinants related to the social services perspective are lacking. Objective: This study aims to explore the determinants of implementing the Fik@ room, a new, co-designed, and research-based ICT tool for social interaction among older people, from a social services personnel perspective. Methods: This study used an exploratory, qualitative design. An ICT tool called the Fik@ room was tested in an intervention study conducted in 2021 in 2 medium-sized municipalities in Sweden. Informants in this study were municipal social services personnel with experience of implementing this specific ICT tool in social services. We conducted a participatory workshop consisting of 2 parts, with 9 informants divided into 2 groups. We analyzed the data using qualitative content analysis with an inductive approach. Results: The results included 7 categories of determinants for implementing the ICT tool. Being able to introduce the ICT tool in an appropriate manner concerns the personnel’s options for introducing and supporting the ICT tool, including their competencies in using digital equipment. Organizational structure concerns a structure for communication within the organization. Leadership concerns engagement and enthusiasm as driving forces for implementation. The digital maturity of the social services personnel concerns the personnel’s skills and attitudes toward using digital equipment. Resources concern time and money. IT support concerns accessibility, and legal liability concerns possibilities to fulfill legal responsibilities. Conclusions: The results show that implementation involves an entire organization at varying degrees. Regardless of how much each level within the organization comes into direct contact with the ICT tool, all levels need to be involved to create the necessary conditions for successful implementation. The prerequisites for the implementation of an ICT tool will probably change depending on the digital maturity of future generations. As this study only included 9 informants, the results should be handled with care. The study was performed during the COVID-19 pandemic, which has probably affected the results.

  • 2.
    Gusdal, Annelie K
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Family caregiving for persons with heart failure: Perspectives of family caregivers, persons with heart failure and registered nurses2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Heart failure is a growing public health problem associated with significant morbidity and mortality. Family support positively affects outcomes for the person with heart failure while also leading to caregiver burden. Registered nurses have a key role in supporting and meeting the needs of family caregivers.

    The overall aim was to explore the situation and needs of family caregivers to a person with heart failure, and explore requisites and ways of supporting and involving family caregivers in heart failure nursing care.

    Two interview studies, one web survey study and one intervention study were conducted between 2012 and 2017. A total of 22 family caregivers, eight persons with heart failure and 331 registered nurses participated in the studies.

    Family caregivers' daily life was characterized by worry, uncertainty and relational incongruence but salutogenic behaviours restored new strength and motivation to care. Family caregivers experienced that their caregiving was taken for granted by health care professionals. Family caregivers expressed a need for a permanent health care contact and more involvement in the planning and implementation of their near one’s health care together with health care professionals. Registered nurses acknowledged family caregivers’ burden, lack of knowledge and relational incongruence. A registered nurse was suggested as a permanent health care contact to improve continuity and security. Registered nurses neither acknowledged family caregivers as a resource nor their need for involvement. Registered nurses working in primary health care centres, in nurse-led heart failure clinics, with district nurse specialization, with education in cardiac nursing care held the most supportive attitudes toward family involvement in heart failure nursing care. Family health conversations via telephone in nurse-led heart failure clinics were found to successfully support and involve families. The conversations enhanced nurse-family relationship and relations within the family. They also provided registered nurses with new, relevant knowledge and understanding about the family as a whole. Family health conversations via telephone were feasible to both families and registered nurses, although fewer and shorter conversations were preferred by registered nurses.

    This thesis highlights the divergence between family caregivers’ experiences and needs, and registered nurses’ perceptions about family caregivers’ situation and attitudes toward the importance of family involvement. It adds to the knowledge on the importance to acknowledge family caregivers as a resource and to support and involve them in heart failure nursing care. One feasible and successful way is to conduct Family health conversations via telephone in nurse-led heart failure clinics.

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  • 3.
    Gusdal, Annelie K
    et al.
    Nursing Care RandD Unit, Centre for Public Health, Huddinge, Sweden.
    Beckman, Christel
    Nursing Care RandD Unit, Centre for Public Health, Huddinge, Sweden.
    Wahlström, Rolf
    Department of Public Health Sciences, Division of Global Health (IHCAR), Stockholm, Sweden.
    Törnkvist, Lena
    Nursing Care RandD Unit, Centre for Public Health, Huddinge, Sweden.
    District nurses' use for an assessment tool in their daily work with elderly patients' medication management2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 4, p. 354-360, article id 21273229Article in journal (Refereed)
    Abstract [en]

    Aim: To explore the capability of the Safe Medication Assessment (SMA) tool in identifying factors highly related to unsafe medication management among elderly patients and to investigate the district nurses' (DNs) opinions of the SMA's usefulness as a tool in their daily primary healthcare practice. Introduction: Elderly patients who experience many medical conditions often use multiple drugs. As well as the combined decline in physical and cognitive functions, the elderly are at high risk for medication-related problems. It is essential to develop a screening procedure to distinguish elderly at risk of an unsafe medication management. Methods: An explorative study. During a 3-6-month period, 25 voluntary DNs used SMA with 160 patients (consecutively chosen and meeting four specified criteria) in their daily practice. Furthermore, DNs responded to questions regarding SMA's usefulness. Results: The result showed that SMA had the capability to identify factors highly related to unsafe medication management among the elderly included in the study. In 64% of assessments DNs identified areas of new information and in 23% of the assessments DNs intervened. They found SMA to be satisfactory regarding its level of simplicity, relevance, completeness, intelligibility, and time for implementation. Conclusions: SMA alerted the DNs to patients' attitudes about medication and empowered them in identifying elderly patients who had unsafe medication management. SMA was also perceived as a useful assessment tool by the DNs.

  • 4.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Florin, Ulrika
    Mälardalen University, School of Innovation, Design and Engineering, Innovation and Product Realisation.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eklund, Caroline
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fritz, Johanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Older Adults’ Use of a Research-Based Web Platform for Social Interaction2023In: Healthcare, E-ISSN 2227-9032, Vol. 11, no 3, article id 408Article in journal (Refereed)
    Abstract [en]

    Loneliness and social isolation are triggers for unfavorable changes in older adults’ health and well-being. Information and communication technology (ICT) can be used by older adults to mitigate the negative effects of loneliness and social isolation. However, ICT needs to be customized to the specific needs and conditions of older adults. The aim of this study was to explore older adults’ use of a new, co-designed and research-based web platform for social interaction from the perspectives of older adults, researchers, and social services personnel. The study is an intervention study with a multimethod approach in which 20 older adults used the web platform for social interaction “the Fik@ room” for eight weeks. Quantitative and qualitative data were collected pretest, during the test, and posttest. The Fik@ room met the expectations of those older adults who completed the study. It enabled them to expand their social network and develop new friendships, but their experiences of loneliness were not reduced. The involvement of social services personnel in recruitment and support was important in facilitating older adults’ use of the Fik@ room. Our study contributes knowledge about a new, co-designed and research-based web platform, customized specifically for older adults, which is valuable in guiding the design and delivery of future web platforms for social interaction among older adults.

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  • 5.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Christine
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Using a Rocking Chair in the Care of People with Dementia: A Single-Case Research Study2020In: OBM Geriatrics, ISSN 2638-1311, Vol. 4, no 2Article in journal (Refereed)
    Abstract [en]

    The people with dementia experience a progressive loss of cognition, while more than 90% of them develop behavioral and psychological symptoms of dementia (BPSD). BPSD may result in physical injuries and psychological distress among people with dementia and their family/caregivers. First-line care strategies in dementia care should not unthinkingly involve pharmacological interventions to avert or reduce the behavior, and should rather consider the person and their unique requirements. Therefore, a combination of pharmacological and non-pharmacological interventions is strongly recommended. Since the care staff in dementia care is required to be informed regarding the non-pharmacological approaches to address BPSD, the present study was aimed to evaluate the use of a rocking chair in the context of BPSD, quality of life, and medication usage among people with dementia at individual level. The secondary aim of the present study was to describe care staff’s experiences related to the feasibility and usability of rocking chair in providing care for PwD in a nursing home setting. The present research is a single-case study, performed using a mixed-methods approach, with six people having dementia and 11 care staff members in a nursing home setting. The people with dementia used the ErgoNova Rocking chair® for a mean number of five times/week, for eight weeks in total. Quantitative and qualitative data were collected prior to, during, and post-intervention (A-B-A design). The quantitative and qualitative data were consistent with each other. The mean, median, and relative change measures indicated a decrease in the BPSD symptoms, such as aberrant motor behavior, agitation, apathy, depression, irritability, and night-time behavior disturbances, and increased quality of life upon using the ErgoNova Rocking chair®. It was also considered to be feasible, usable, and non-labor-intensive intervention by the care staff. The obtained data suggested that the use of ErgoNova Rocking chair® provided short-term relief from aberrant motor behavior, agitation, apathy, depression, irritability, and night-time behavior disturbances, along with an increase in the quality of life of the person with dementia. The use of ErgoNova Rocking chair® may serve as a complementary tool to the non-pharmacological management techniques for people with dementia in nursing homes.

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  • 6.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Mälardalens Högskola.
    Gustafsson, Christine
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Virtual Reality in the Care of People with Dementia: A Single-Case Research Study2020In: Journal of Patient Care and Services, Vol. 1, no 1, p. 4-31Article in journal (Refereed)
    Abstract [en]

    More than 90% of people with dementia develop behavioral and psychological symptoms of dementia. First-line care strategies in dementia care should consider a combination of pharmacological and non-pharmacological interventions. The present single-case research study aimed to evaluate the use of virtual reality in the context of behavioral and psychological symptoms of dementia, quality of life, and medication use among people with dementia. Ten persons with dementia used virtual reality for a mean of twice per week for eight weeks. In each virtual reality session, lasting for a maximum of 30 minutes, the persons with dementia chose one to three short films from 11 different films: a hen run, a farm with animals, two cafés, an old-fashioned grocery shop, a local river, a square in the local city, a museum, a castle, a fishing boat and an Austrian mountain scenery. Quantitative and qualitative data were collected pre-, during, and post-intervention. No major differences in the quantitative data in terms of behavioral and psychological symptoms of dementia, quality of life, or medication use were observed. However, the qualitative data showed that the use of virtual reality provided the persons with dementia with short-term enjoyment, heightened energy and alertness, and an experience of reminiscence. The use of virtual reality may therefore serve as a complementary tool to the existing non-pharmacological management techniques of people with dementia in nursing homes.

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  • 7.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Arkkukangas, Marina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Ekholm, A.
    Research and Development in Sörmland, Eskilstuna, Sweden.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. PrILiv - Långvarigt självständigt liv.
    Preventing Falls and Malnutrition among Older Adults in Municipal Residential Care in Sweden: A Registry Study2021In: Sage Open Nursing, E-ISSN 2377-9608, Vol. 7Article in journal (Refereed)
    Abstract [en]

    Introduction: Older adults in municipal residential care are among the most vulnerable and in need of most care. The prevalence of negative events, such as falls and malnutrition, is increased among these older adults. The need for strategies to prevent falls and malnutrition is emphasized in guidelines and systematic, individualized risk assessments are prerequisites for adequate interventions. Objectives: The overall purpose of this study was to investigate the assessed risks of, and risk factors for, falling and malnutrition and the correlations between these assessed risks among older women and men in residential care. Further, the purpose was to investigate the consistency between planned and performed interventions among women and men assessed as at risk. Methods: A cross-sectional registry study based on risk assessment data in the Swedish national quality registry, Senior Alert. Altogether, 5,919 older adults ≥65 in nursing homes and dementia care units in 19 municipalities in Sweden were included. Results: Of the older adults, 77% were at risk of falls, and 59% were at risk of malnutrition. The most prevalent risk factors for falls were previous falls and not being cognitively oriented; and for malnutrition were having mild or severe dementia or depression. A significant positive correlation between the risk of falling and the risk of malnutrition was found. Less than half of the planned interventions for falls and malnutrition were performed. Care staff’s least common interventions to prevent falls were balance, muscular function, and strength training, which contrasts with the recommendations; interventions to prevent malnutrition were only partially adhering to recommendations. Conclusions: This cross-sectional registry study points towards the importance of using an evidence-based approach, based on adherence to recommended guidelines, in the prevention of falling and malnutrition. Further, the implementation of clinical practice guidelines is needed, which requires educational training for care staff and supportive leadership.

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  • 8.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Prerequisites for a healthy and independent life among older people: a Delphi study2021In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 41, no 9, p. 2171-2187Article in journal (Refereed)
    Abstract [en]

    The number of older people (aged 65+) will more than double by 2050 in Sweden. The ageing population is an increasing concern due to rising health-care costs and a shortage of health professionals. Older people generally prefer ageing in place, as long as they feel confident and comfortable. However, preventive and supportive measures are needed to maintain older people’s independence and active participation in society. The aim of this study is to explore the prerequisites for a healthy and independent life among older people in Sweden. A Delphi study was conducted in three rounds. In round 1, seven focus group interviews were performed with older persons aged 65–79, older persons aged ⩾80, next of kin of older persons, health professionals in primary and home health care, assistant nurses in home care, care managers and local politicians. The data were analysed using thematic analysis, resulting in 35 statements of the prerequisites needed for a healthy and independent life. These statements were sent to the participants from round 1, who were asked to evaluate the degree to which they agreed with each statement in round 2, and again in round 3. There was an agreement of at least 80 per cent for 31 of the 35 statements. When asked to identify the three prerequisites of most importance for a healthy and independent life, most participants stated: to have a social life, to have freedom of choice and power over one’s own situation, and to have the possibility to choose independently one’s type of housing. There was an overall high group agreement on the prerequisites needed for a healthy and independent life among older people. The main areas of importance were to have a social life, several dimensions of feeling safe and to retain one’s personal control.

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  • 9.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Malardalen Univ, Sch Hlth Care & Social Welf, Eskilstuna, Sweden..
    Josefsson, K.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, Boras, Sweden..
    Adolfsson, E. Thors
    Cty Council Vastmanland, Vastmanlands Hosp Vasteras, Primary Hlth Care, Vasteras, Sweden..
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Registered nurses' perceptions about the situation of family caregivers to patients with heart failure a focus group interview study2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, p. S83-S83Article in journal (Other academic)
  • 10.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Josefsson, Karin
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare Department of Caring Science.
    Thors Adolfsson, Eva
    Västmanland County Hospital, Department of Primary Health Care, Västerås, Sweden.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Family Health Conversations Conductedby Telephone in Heart Failure Nursing Care: A Feasibility Study2018In: Sage Open Nursing, E-ISSN 2377-9608, Vol. 4, p. 1-13Article in journal (Refereed)
    Abstract [en]

    Registered nurses (RNs) in heart failure (HF) nursing care have a key role in providing family support, which positively affectsthe outcome for the patient. Telephone interventions conducted by RNs have been reported to be successful in HF nursingcare, but Family Health Conversations (FamHCs) involving the patient and the family, have not previously been tested. Thepurpose of the current study was to explore the experiences and feasibility of nurse-led FamHCs conducted by telephonewith patients and their family caregivers. A single-group intervention study with a pretest–posttest design was conducted inthree regional hospitals that had a nurse-led HF clinic. Five RNs, eight patients, and eight family caregivers participated. ThreeFamHCs were conducted by telephone with each family every 2 weeks. Qualitative and quantitative data were collectedthrough semistructured interviews and questionnaires. FamHCs improved the nurse–family relationships and relationshipswithin the families and provided RNs with new knowledge about the families. FamHCs conducted by telephone wereconsidered to be feasible for both families and RNs, although RNs preferred fewer and shorter FamHCs. The RNs preferredmeeting face-to-face with the families as nonverbal communication between the family members could be missed because oflack of visual input. On the other hand, RNs appreciated to focus entirely on the conversation without the need to performillness-related routine checks. In conclusion, the advantages of FamHCs conducted by telephone outweighed the disadvantages.Visual contact, provided by video telephony, and a shorter version of the tested FamHC would facilitate the use in HFnursing care.

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  • 11.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Josefsson, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Thors Adolfsson, Eva
    Vastmanlands Hosp Vasteras, Sweden.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Informal caregivers’ experiences and needs in caring for near ones with chronic heart failure in ordinary homes: An interview study.2014In: European Journal of Heart Failure / [ed] Prof. Marco Metra, 2014, Vol. 16 (2), p. 124-124Conference paper (Other academic)
  • 12.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Josefsson, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Thors Adolfsson, Eva
    Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västerås, Sweden.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Informal Caregivers' Experiences and Needs When Caring for a Relative With Heart Failure: An Interview Study2016In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, no 4, p. E1-E8, article id 25419945Article in journal (Refereed)
    Abstract [en]

    Background: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden. Objective: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home. Methods: The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis. Results: Two themes emerged: "living in a changed existence" and "struggling and sharing with healthcare." The first theme describes informal caregivers' experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative's symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative's healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by healthcare professionals. Conclusions: Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of "self" and of "us." Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative.

  • 13.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Josefsson, Karin
    Univ Borås, Fac Caring Sci Work Life & Social Welf, Borås, Sweden..
    Thors Adolfsson, Eva
    Cty Council Västmanland, Västmanlands Hosp Västerås, Primary Hlth Care, Västerås, Sweden..
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nurses’ Attitudes toward Family Importance in Heart Failure Care2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 3, p. 256-266Article in journal (Refereed)
    Abstract [en]

    Background: Support from the family positively affects self-management, patient outcomes and the incidence of hospitalizations among patients with heart failure (HF). To involve family members in HF care is thus valuable for the patients. Registered nurses (RNs) frequently meet family members to patients with HF and the quality of these encounters are likely to be influenced by the attitudes RNs hold toward families.

    Aims: To explore RNs' attitudes toward the importance of families' involvement in HF nursing care and to identify factors that predict the most supportive attitudes.

    Methods: Cross-sectional, multicentre web-survey study. A sample of 303 RNs from 47 hospitals and 30 primary health care centres (PHCC) completed the instrument Families’ Importance in Nursing Care - Nurses’ Attitudes.

    Results: Overall, RNs were supportive of families' involvement. Nonetheless, attitudes toward inviting families to actively take part in HF nursing care and involve families in planning of care were less supportive. Factors predicting the most supportive attitudes were to work in a PHCC, a HF clinic, a workplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and or HF nursing care, and a competence to work with families.

    Conclusions: Experienced RNs in HF nursing care can be encouraged to mentor their younger and less experienced colleagues to strengthen their supportive attitudes toward families. RNs who have designated consultation time with patients and families, as in a nurse-led HF clinic, may have the most favourable condition for implementing a more supportive approach to families.

  • 14.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Josefsson, Karin
    Univ Borås, Fac Caring Sci Work Life & Social Welf, Borås, Sweden..
    Thors Adolfsson, Eva
    Cty Council Västmanland, Västmanlands Hosp Västerås, Primary Hlth Care, Västerås, Sweden.
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Registered nurses' perceptions about the situation of family caregivers to patients with heart failure a focus group interview study2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 8, p. E1-E18Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Heart failure is a growing public health problem associated with poor quality of life and significant morbidity and mortality. The majority of heart failure care is provided by family caregivers, and is associated with caregiver burden and reduced quality of life. Research emphasizes that future nursing interventions should recognize the importance of involving family caregivers to achieve optimal outcomes.

    AIMS: The aims of this study are to explore registered nurses' perceptions about the situation of family caregivers to patients with heart failure, and registered nurses' interventions, in order to improve family caregivers' situation.

    METHODS: The study has a qualitative design with an inductive approach. Six focus group interviews were held with 23 registered nurses in three hospitals and three primary health care centres. Data were analysed using qualitative content analysis.

    RESULTS: Two content areas were identified by the a priori study aims. Four categories and nine sub-categories emerged in the analysis process. The content area "Family caregivers' situation" includes two categories: "To be unburdened" and "To comprehend the heart failure condition and its consequences". The content area "Interventions to improve family caregivers' situation" includes two categories: "Individualized support and information" and "Bridging contact".

    CONCLUSIONS: Registered nurses perceive family caregivers' situation as burdensome, characterized by worry and uncertainty. In the PHCCs, the continuity and security of an RN as a permanent health care contact was considered an important and sustainable intervention to better care for family caregivers' worry and uncertainty. In the nurse-led heart failure clinics in hospitals, registered nurses can provide family caregivers with the opportunity of involvement in their relative's health care and address congruence and relationship quality within the family through the use of "Shared care" and or Family-centred care. Registered nurses consider it necessary to have a coordinated individual care plan as a basis for collaboration between the county council and the municipality.

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  • 15.
    Gusdal, Annelie K
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Obua, Celestino
    Makerere University, Kampala, Uganda.
    Andualem, Tenaw
    Strengthening Pharmaceutical Systems, Management Sciences for Health, Addis Ababa, Ethiopia.
    Wahlström, Rolf
    Karolinska Institutet, Stockholm, Sweden.
    Chalker, John
    Centre for Pharmaceutical Management, Management Sciences for Health, Arlington, United States.
    Fochsen, Grethe
    Karolinska Institutet, Stockholm, Sweden.
    Peer counselors' role in supporting patients' adherence to ART in Ethiopia and Uganda2011In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 23, no 6, p. 657-662, article id 21347887Article in journal (Refereed)
    Abstract [en]

    Our aim was to explore peer counselors' work and their role in supporting patients' adherence to antiretroviral treatment (ART) in resource-limited settings in Ethiopia and Uganda. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Two main categories with related subcategories emerged from the analysis. The first main category, peer counselors as facilitators of adherence, describes how peer counselors played an important role by acting as role models, raising awareness, and being visible in the community. They were also recognized for being close to the patients while acting as a bridge to the health system. They provided patients with an opportunity to individually talk to someone who was also living with HIV, who had a positive and life-affirming attitude about their situation, and were willing to share personal stories of hope when educating and counseling theirpatients. The second main category, benefits and challenges of peer counseling, deals with how peer counselors found reward in helping others while at the same time acknowledging their limitations and need of support and remuneration. Their role and function were not clearly defined within the health system and they received negligible financial and organizational support. While peer counseling is acknowledged as an essential vehicle for treatment success in ART support in sub-Saharan Africa, a formal recognition and regulation of their role should be defined. The issue of strategies for disclosure to support adherence, while avoiding or reducing stigma, also requires specific attention. We argue that the development and implementation of support to peer counselors are crucial in existing and future ART programs, but more research is needed to further explore factors that are important to sustain and strengthen the work of peer counselors.

  • 16.
    Gusdal, Annelie K
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Obua, Celestino
    Makerere University Medical School, Kampala, Uganda.
    Andualem, Tenaw
    Management Sciences for Health, Addis Ababa, Ethiopia.
    Wahlström, Rolf
    Karolinska Institutet, Stockholm, Sweden.
    Tomson, Göran
    Karolinska Institutet, Stockholm, Sweden.
    Peterson, Stefan
    Karolinska Institutet, Stockholm, Sweden.
    Ekström, Anna-Mia
    Karolinska Institutet, Stockholm, Sweden.
    Thorson, Anna
    Karolinska Institutet, Stockholm, Sweden.
    Chalker, John
    Center for Pharmaceutical Management, Management Sciences for Health, Arlington, VA, United States.
    Fochsen, Grethe
    Karolinska Institutet, Stockholm, Sweden.
    Voices on adherence to ART in Ethiopia and Uganda: a matter of choice or simply not an option?2009In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 21, no 11, p. 1381-1387, article id 20024714Article in journal (Refereed)
    Abstract [en]

    This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: "Patients' competing costs and systems' resource constraints'' and "Patients' trust in ART and quality of the patient-provider encounters.'' The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling.

  • 17.
    Gusdal, Annelie K
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderman, Mirkka
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Pettersson, Tina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kaup, Jaana
    Mälardalen University, School of Health, Care and Social Welfare.
    Gustafsson, Lena-Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Healthcare and social care professionals’ experiences of respite care: a critical incident study2024In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 19, no 1Article in journal (Refereed)
    Abstract [en]

    IntroductionAging in place is favoured among older persons and supported by research in Sweden, although it poses challenges for overburdened informal caregivers. While respite care can offer support, its accessibility is hindered by organizational challenges and informal caregivers' delays in using it. The experiences of informal caregivers are well-studied, but the professionals' experiences of respite care quality and critical incident management are underexplored.AimTo explore professionals' experiences of critical incidents in respite care, consequences for the persons being cared for, and strategies to manage critical incidents.Materials and methodsA qualitative, critical incident technique was used, and three group interviews with a total of 16 professionals were conducted.ResultsBarriers to quality respite care included communication gaps during care transitions, environmental shortcomings in respite care facilities, lack of support for informal caregivers, and inadequacies in respite care decisions. Strategies to manage critical incidents included individualized care, continuity and communication in care transitions, a conducive environment, support for informal caregivers, and care professionals' positive approach.ConclusionsThe study emphasizes the need for focused efforts on communication, continuity, and a supportive environment. Addressing identified challenges and applying suggested strategies will be key to maximizing the potential of respite care as a vital support for care recipients and their informal caregivers.

  • 18.
    Gustafsson, Lena-Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderman, Mirkka
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bondesson, Anna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Pettersson, Tina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Östlund, Gunnel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gusdal, Annelie K
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Växelvård idag och i framtiden2023Report (Other academic)
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  • 19.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Alam, Moudud
    Dalarna Univ, Sch Informat & Engn Stat, Falun, Sweden..
    Gusdal, Annelie K
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Dalarna Univ, Sch Hlth & Welf, Falun, Sweden..
    Boström, Anne-Marie
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;R&D unit, R&D Unit, Stockholm, Sweden.;Karolinska Univ Hosp, Theme Inflammat & Aging, Huddinge, Sweden..
    Trust and easy access to home care staff are associated with older adults' sense of security: a Swedish longitudinal study2024In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aim: Older adults are increasingly encouraged to continue living in their own homes with support from home care services. However, few studies have focused on older adults' safety in home care. This study explored associations between the sense of security and factors related to demographic characteristics and home care services.Methods: The mixed longitudinal design was based on a retrospective national survey. The study population consisted of individuals in Sweden (aged 65+ years) granted home care services at any time between 2016 and 2020 (n=82,834-94,714). Multiple ordinal logistic regression models were fitted using the generalised estimation equation method to assess the strength of relationship between the dependent (sense of security) and independent (demographics, health and care-related factors) variables.Results: The sense of security tended to increase between 2016 and 2020, and was significantly associated with being a woman, living outside big cities, being granted more home care services hours or being diagnosed/treated for depression (cumulative odds ratio 2-9% higher). Anxiety, poor health and living alone were most strongly associated with insecurity (cumulative odds ratio 17-64% lower). Aside from overall satisfaction with home care services, accessibility and confidence in staff influenced the sense of security most.Conclusions: We stress the need to promote older adults' sense of security for safe ageing in place, as mandated by Swedish law. Home care services profoundly influence older adults' sense of security. Therefore, it is vital to prioritise continuity in care, establish trust and build relationships with older adults. Given the increasing shortage of staff, integrating complementary measures, such as welfare technologies, is crucial to promoting this sense of security.

  • 20.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Alam, Moudud
    Dalarna University, Sweden.
    Gusdal, Annelie K
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Lövenmark [Åberg] [Engström], Annica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Boström, Anne-Marie
    Karolinska Institutet, Sweden; Karolinska sjukhuset, Sweden; Stockholms sjukhem, Sweden.
    Hammar, Lena Marmstål
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden.
    Anxiety and loneliness among older people living in residential care facilities or receiving home care services in Sweden during the COVID-19 pandemic: a national cross-sectional study2022In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 22, no 1, article id 927Article in journal (Refereed)
    Abstract [en]

    Background: Older people were subjected to significant restrictions on physical contacts with others during the COVID-19 pandemic. Social distancing impacts older people’s experiences of anxiety and loneliness. Despite a large body of research on the pandemic, there is little research on its effects on older people in residential care facilities (RCF) and in home care services (HCS), who are the frailest of the older population. We aimed to investigate the effect of the first wave of the COVID-19 pandemic in March-May 2020 on experiences of anxiety and loneliness among older people living in RCF or receiving HCS and the impact of the progression of the pandemic on these experiences.

    Methods: A retrospective cross-sectional design using data from the national user satisfaction survey (March − May 2020) by the Swedish National Board of Health and Welfare. Survey responses were retrieved from 27,872 older people in RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 years). Proportional-odds (cumulative logit) model was used to estimate the degree of association between dependent and independent variables.

    Results: Loneliness and anxiety were more prevalent among the older persons living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 47%, respectively). Proportional odds models revealed that among the RCF and HCS respondents, the cumulative odds ratio of experiencing higher degree of anxiety increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated health was the most influential factor for anxiety in both RCF and HCS. Living alone (with HCS) was the most influential factor affecting loneliness. Experiences of disrespect from staff were more strongly associated with anxiety and loneliness in RCF than in HCS.

    Conclusion: Older people in RCF or receiving HCS experienced increasing levels of anxiety and loneliness as the first wave of the pandemic progressed. Older people’ mental and social wellbeing should be recognized to a greater extent, such as by providing opportunities for social activities. Better preparedness for future similar events is needed, where restrictions on social interaction are balanced against the public health directives.

  • 21.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gusdal, Annelie K
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eklund, Caroline
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Florin, Ulrika
    Mälardalen University, School of Innovation, Design and Engineering, Innovation and Product Realisation.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    A codesigned web platform for reducing social isolation and loneliness in older people: a feasibility studyIn: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165Article in journal (Refereed)
    Abstract [en]

    Social isolation and loneliness are associated with negative health outcomes, physical as well as cognitive. Information and communication technology (ICT) can be effective tools for preventing and tackling social isolation and loneliness among older people. Our objective was to evaluate the feasibility of the Fik@ room, a web platform for social interaction designed for older people. A mixed methods design was applied, where both quantitative and qualitative data were collected during a 12-week period (n = 28, Md age 74). Experiences of loneliness were reduced using the Fik@ room. The results highlight the feasibility issues surrounding the recruitment process, adoption, pattern of use, usability, support service, and technical infrastructure. In particular, the importance of offering ICT solutions with few technical issues, and to provide easily accessible and appropriate support. The Fik@ room is a feasible tool for older people to develop new friendships, reduce loneliness, and grow their social networks. However, it is not a communication option that fits all. The results offer a compilation of feasibility issues that can serve as an inspirational guide in the design and implementation of similar technologies. 

  • 22.
    Johansson-Pajala, Rose-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Christine
    Sopiahemmet Univ, Stockholm, Sweden..
    Gusdal, Annelie K
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    No thank you to humanized robots: attitudes to care robots in elder care services2022In: Home Health Care Services Quarterly, ISSN 0162-1424, E-ISSN 1545-0856, Vol. 41, no 1, p. 40-53Article in journal (Refereed)
    Abstract [en]

    The growing older population will increase the demands on the health and welfare systems, including elder care services. One way of meeting these growing service needs is to shift from traditional care services to technologically oriented services. Robotic innovations are gradually being introduced to elder care services. The aim was to explore attitudes toward the use of care robots in elder care services - specifically focusing on situations and interaction, influence, and emotions in interaction with care robots. Data were obtained from visitors at a welfare technology fair (n = 124). The results show that the most negative attitudes concerned if the care robots were humanized and had emotions. The attitudes toward interacting with care robots in general were predominately positive. In conclusion, concrete usage scenarios in elder care services need to be detected, based both on users' needs, digital literacy and on the maturity of the technology itself.

  • 23.
    Obua, Celestino
    et al.
    Makerere University, Kampala, Uganda.
    Gusdal, Annelie K
    Karolinska Institutet, Stockholm, Sweden .
    Waako, Paul
    Makerere University, Kampala, Uganda.
    Chalker, John
    Center for Pharmaceutical Management, Management Sciences for Health, Arlington, VA, United States.
    Tomson, Göran
    Karolinska Institutet, Stockholm, Sweden .
    Wahlström, Rolf
    Karolinska Institutet, Stockholm, Sweden .
    Multiple ART Programs Create a Dilemma for Providers to Monitor ARV Adherence in Uganda2011In: Open AIDS Journal, ISSN 1874-6136, Vol. 5, p. 17-24, article id 21629504Article in journal (Refereed)
    Abstract [en]

    Background: Increased availability and accessibility of antiretroviral therapy (ART) has improved the length and quality of life amongst people living with HIV/AIDS. This has changed the landscape for care from episodic to longterm care that requires more monitoring of adherence. This has led to increased demand on human resources, a major problem for most ART programs. This paper presents experiences and perspectives of providersin ART facilities, exploring the organizational factors affecting their capacity to monitor adherence to ARVs. Methods: From an earlier survey to test adherence indicators and rank facilities as good, medium or poor adherence performances, six facilities were randomly selected, two from each rank. Observations on facility set-up, provider-patient interactions and key informant interviews were carried out. The strengths, weaknesses, opportunities and threats identified by health workers as facilitators or barriers to their capacity to monitor adherence to ARVs were explored during group discussions. Results: Findings show that the performance levels of the facilities were characterized by four different organizational ARTprograms operating in Uganda, with apparent lack of integration and coordination at the facilities. Of the six facilities studied, the two highadherence performing facilities were Non-Governmental Organization (NGO) programs, while facilities with dual organizational programs(Governmental/NGO) performed poorly. Working conditions, record keeping and the duality of programs underscored the providers' capacity tomonitor adherence. Overall 70% of the observed provider-patient interactions were conducted in environments that ensured privacy of the patient. The mean performance for record keeping was 79% and 50% in the high and low performing facilities respectively. Providers often found it difficult to monitor adherence due to the conflicting demands from the different organizational ART programs. Conclusion: Organizational duality at facilities is a major factor in poor adherence monitoring. The different ART programs in Uganda need to be coordinated and integrated into a single well resourced program to improve ART services and adherence monitoring. The focus on long-term care of patients on ART requires that the limitations to providers' capacity for monitoring adherence become central during the planning and implementation of ART programs.

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  • 24.
    von Heideken Wågert, Petra
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Florin, Ulrika
    Mälardalen University, School of Innovation, Design and Engineering, Innovation and Product Realisation.
    Gusdal, Annelie K
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eklund, Caroline
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Johansson-Pajala, Rose-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    FIK@RUMMET– en webb-plattform för minskad ensamhet och social isolering2022In: Ä, ISSN 2001-1164, no 3, p. 12-14, article id oktoberArticle in journal (Other (popular science, discussion, etc.))
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